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Preanalytical error

Caitlyn R Martinez, Kelly S Santangelo
Synovial fluid analysis is a key component of the minimum database needed to diagnose and manage primary and secondary articular joint disorders. Unfortunately, preanalytical variables can drastically alter samples submitted for evaluation to veterinary laboratories and it is considered the stage at which most laboratory error occurs. This article addresses common sources of preanalytical variability and error that are seen in veterinary medicine. With consistent quality control and reporting of specimens, downstream clinical decision making and management of patients can be accelerated and improved...
October 5, 2016: Veterinary Clinics of North America. Small Animal Practice
J G Toffaletti, C R Rackley
Although part of a common "blood gas" test panel with pH and pCO2, the pO2, %O2Hb, and related parameters are independently used to detect and monitor oxygen deficits from a variety of causes. Measurement of blood gases and cooximetry may be done by laboratory analyzers, point of care testing, noninvasive pulse oximetry, and transcutaneous blood gases. The specimen type and mode of monitoring oxygenation that are chosen may be based on a combination of urgency, practicality, clinical need, and therapeutic objectives...
2016: Advances in Clinical Chemistry
Rachel D Le, Stacy E F Melanson, Athena K Petrides, Ellen M Goonan, Ida Bixho, Adam B Landman, Anne Marie Brogan, David W Bates, Milenko J Tanasijevic
OBJECTIVES: Most preanalytical errors at our institution occur during nonphlebotomy blood draws. We implemented an electronic health record (EHR), interfaced the EHR to the laboratory information system, and designed a new specimen collection module. We studied the effects of the new system on nonphlebotomy preanalytical errors. METHODS: We used an electronic database of preanalytical errors and calculated the number and type of the most common errors in the emergency department (ED) and inpatient nursing for 3-month periods before (August-October 2014) and after (August-October 2015) implementation...
October 2016: American Journal of Clinical Pathology
S N Narla, M Jones, K L Hermayer, Y Zhu
Maintaining blood glucose concentration within an acceptable range is a goal for patients with diabetes mellitus. Point-of-care glucose meters initially designed for home self-monitoring in patients with diabetes have been widely used in the hospital settings because of ease of use and quick reporting of blood glucose information. They are not only utilized for the general inpatient population but also for critically ill patients. Many factors affect the accuracy of point-of-care glucose testing, particularly in critical care settings...
2016: Advances in Clinical Chemistry
Olaf Stanger, Brigitta Gahl, Michael Grabherr, Richard Krausler, Sarah Longnus, Andreas Meinitzer, Janne Cadamuro
BACKGROUND: Use of the Freedom SOLO (FS) stentless aortic bioprosthesis is limited by a unique and as yet unexplained severe decrease in postoperative platelet count in the absence of FS-related excess bleeding or thromboembolism. We investigated whether anticoagulant-associated pseudothrombocytopaenia could explain this complication. METHODS: Thirty consecutive patients (mean age 75.4±7.7 years, 11 [36.7%] female) underwent elective aortic valve replacement (AVR) with either the stented bovine Mitroflow (MF, n=18) or the stentless bovine FS (n=12) aortic valve bioprostheses...
August 16, 2016: Heart, Lung & Circulation
Zlata Flegar-Meštrić, Sonja Perkov, Andrea Radeljak, Mirjana Marijana Kardum Paro, Ingrid Prkačin, Ana Devčić-Jeras
BACKGROUND: Improving quality and patient safety in the medical biochemistry laboratory accredited according to the International Standard Organization (ISO 15189:2012) requires the patient-centered evaluation of errors based on the implementation of quality indicators (QIs) across the total testing process. Our main goal was to achieve quality improvement of the preanalytical process in an emergency laboratory which had the highest error rate using risk management principles. METHODS: Failure mode and effects analysis (FMEA) was applied to analyze predefined preanalytical QIs and score laboratory failures for the failure demerit value (FDV), probability of failure (PF) and probability of failure remedy (PFR)...
August 31, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Eun Jin Lee, Miyoung Kim, Han Sung Kim, Min Jeong Park, Young Kyung Lee, Hee Jung Kang
Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25...
November 2016: Annals of Laboratory Medicine
Zeynep Tosuner, Zühal Gücin, Tuğçe Kiran, Nur Büyükpinarbaşili, Seval Turna, Olcay Taşkiran, Dilek Sema Arici
OBJECTIVE: A major target of quality assurance is the minimization of error rates in order to enhance patient safety. Six Sigma is a method targeting zero error (3.4 errors per million events) used in industry. The five main principles of Six Sigma are defining, measuring, analysis, improvement and control. Using this methodology, the causes of errors can be examined and process improvement strategies can be identified. The aim of our study was to evaluate the utility of Six Sigma methodology in error reduction in our pathology laboratory...
2016: Türk Patoloji Dergisi
Vikram Narang HarsimranKaur, Pavneet Kaur Selhi, Neena Sood, Aminder Singh
BACKGROUND: Quality assurance in the hematology laboratory is a must to ensure laboratory users of reliable test results with high degree of precision and accuracy. Even after so many advances in hematology laboratory practice, pre-analytical errors remain a challenge for practicing pathologists. This study was undertaken with an objective to evaluate the types and frequency of preanalytical errors in hematology laboratory of our center. METHODS: All the samples received in the Hematology Laboratory of Dayanand Medical College and Hospital, Ludhiana, India over a period of one year (July 2013-July 2014) were included in the study and preanalytical variables like clotted samples, quantity not sufficient, wrong sample, without label, wrong label were studied...
2016: Iranian Journal of Pathology
Michael Cornes, Edmée van Dongen-Lases, Kjell Grankvist, Mercedes Ibarz, Gunn Kristensen, Giuseppe Lippi, Mads Nybo, Ana-Maria Simundic
It has been well reported over recent years that most errors within the total testing process occur in the pre-analytical phase (46%-68.2%), an area that is usually outside of the direct control of the laboratory and which includes sample collection (phlebotomy). National and international (WHO, CLSI) guidelines recommend that the order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes that could cause erroneous results...
July 21, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Andrea M Cook, Andreas Moritz, Kathleen P Freeman, Natali Bauer
BACKGROUND: Scarce information exists about quality requirements and objective evaluation of performance of large veterinary bench top hematology analyzers. OBJECTIVE: The study was aimed at comparing the observed total error (TEobs ) derived from meta-analysis of published method validation data to the total allowable error (TEa ) for veterinary hematology variables in small animals based on experts' opinions. Ideally, TEobs should be < TEa . METHODS: An online survey was sent to veterinary experts in clinical pathology and small animal internal medicine for providing the maximal allowable deviation from a given result for each variable...
September 2016: Veterinary Clinical Pathology
D M Adcock, J Mammen, S C Nair, S A de Lima Montalvão
Selected quality issues pertinent to the determination of accurate results in the haemostasis laboratory are discussed. Specifically, the implementation of a successful external quality-assessment scheme is described, including its impact on result accuracy as well as the programme's unique challenges and opportunities. Errors in the preanalytical phase of laboratory testing represent the greatest source for reporting incorrect test results. Some of the most common preanalytical errors are described including those that necessitate sample rejection...
July 2016: Haemophilia: the Official Journal of the World Federation of Hemophilia
Tania Tineo Drove, María Ángeles Santos Ampuero, Ana Díaz López, Francisco Rodríguez Salvanés, Lorena Vega Piris, Mercedes Gómez Puyuelo
Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient.
May 2016: Revista de Enfermería
Tim L Williams, Joy Archer
BACKGROUND: Pseudothrombocytopenia secondary to platelet clumping is a common cause of preanalytic error for platelet counts in dogs, cats, and horses. In human beings, it is suggested that prewarming blood samples to 37°C prior to hematology analysis will reduce platelet clumping. OBJECTIVES: The purpose of the study was to evaluate the effect of prewarming EDTA blood samples to 37°C on measured platelet counts and other hematologic variables. METHODS: The EDTA blood samples from dogs, cats and horses submitted to the clinical pathology laboratory at the University of Cambridge were included...
September 2016: Veterinary Clinical Pathology
I D Osegbe, O Afolabi, C P Onyenekwu
BACKGROUND: Inadequately completed laboratory test request forms contribute to preanalytical errors and limit the advice of pathologists when interpreting laboratory test results. Educating clinicians about this has been proposed by several studies as a strategy to reduce the occurrence. AIM: We aimed to determine the effectiveness of such education on the prevalence of adequately completed laboratory test request forms. SUBJECTS AND METHODS: This was a quasi-experimental study conducted at the chemical pathology laboratory of the Lagos University Teaching Hospital, Nigeria...
March 2016: Annals of Medical and Health Sciences Research
Michael P Cornes, Stephen Church, Edmée van Dongen-Lases, Kjell Grankvist, João T Guimarães, Mercedes Ibarz, Svetlana Kovalevskaya, Gunn Bb Kristensen, Giuseppe Lippi, Mads Nybo, Ludek Sprongl, Zorica Sumarac, Ana-Maria Simundic
Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical phase to provide a forum for National Societies (NS) to discuss their issues...
September 2016: Annals of Clinical Biochemistry
Lora Dukic, Anja Jokic, Josipa Kules, Daria Pasalic
INTRODUCTION: The educational program for health care personnel is important for reducing preanalytical errors and improving quality of laboratory test results. The aim of our study was to assess the level of knowledge on preanalytical phase in population of biomedicine students through a cross-sectional survey. MATERIALS AND METHODS: A survey was sent to students on penultimate and final year of Faculty of Pharmacy and Biochemistry--study of medical biochemistry (FPB), Faculty of Veterinary Medicine (FVM) and School of Medicine (SM), University of Zagreb, Croatia, using the web tool SurveyMonkey...
2016: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Juliane Dorow, Susen Becker, Linda Kortz, Joachim Thiery, Sunna Hauschildt, Uta Ceglarek
BACKGROUND: Preanalytical variables have a great impact on sample matrices and are a source of laboratory errors. The effect of cryobanking, which is gaining great importance recently, requires systematic investigation. The arachidonic acid metabolism is useful as a quality marker since eicosanoids are easily subjected to in vitro oxidation processes. MATERIALS AND METHODS: Polyunsaturated fatty acids (PUFAs) and related metabolites were analyzed by online solid-phase extraction coupled to liquid chromatography-tandem mass spectrometry...
April 2016: Biopreservation and Biobanking
Teresa D Samulski, Kathleen Montone, Virginia LiVolsi, Ketan Patel, Zubair Baloch
Because of the unique systems and skills involved in patient care by the pathologist, it is challenging to design and implement relevant training in patient safety for pathology trainees. We propose a patient safety curriculum for anatomic pathology (AP) residents based on our institutional experience. The Hospital of the University of the Pennsylvania employs a self-reporting safety database. The occurrences from July 2013 to June 2015 recorded in this system that involved the division of AP were reviewed and cataloged as preanalytic, analytic, and postanalytic...
March 2016: Advances in Anatomic Pathology
Edmée C van Dongen-Lases, Michael P Cornes, Kjell Grankvist, Mercedes Ibarz, Gunn B B Kristensen, Giuseppe Lippi, Mads Nybo, Ana-Maria Simundic
Venous blood sampling (phlebotomy) is the most common invasive procedure performed in patient care. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI). As the quality of practices and procedures related to venous blood sample collection in European countries was unknown, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase conducted an observational study in 12 European countries...
July 1, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
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